Obstructive Jaundice in Patients with Gastric Cancer

ABSTRACT

PURPOSE: Although obstructive jaundice is a rare presentation, it is an ominous sign of poor prognosis in patients with gastric cancer. Thus, we investigated the incidence, the clinical features, the pathologic characteristics, the treatment modality, and the prognosis for obstructive jaundice in patients with gastric cancer. METHODS: A retrospective analysis was done for patients with gastric cancer who had presented with obstructive jaundice at Korea University Guro Hospital from January 1988 to December 1998. RESULTS: During that period, 2546 patients were diagnosed with gastric cancer, and obstructive jaundice was revealed in 20 (0.78%). The mean age was 58 13 years, and the sex ratio (malefemale) was 5.71. Jaundice was the first presentation in two patients, and it developed in the other 18 patients during the follow-up period after the initial operation or chemotherapy. The level of total bilirubin was 16.7 8.1 mg/dl, and the cause of the jaundice was lymph-node enlargement at the porta hepatis. A percutaneous transhepatic biliary drainage (PTBD) was done in 17 patients, and improvement was seen in 13 (76%). The most common site of the obstruction was common hepatic duct (CHD) (60%). Antrally located, moderately differentiated and Borrmann type-III gastric cancers were commonly associated with obstructive jaundice. The mean duration from jaundice to death was 4.6 6.2 month. CONCLUSION: Obstructive jaundice is very rare in patients with gastric cancer and is associated with poor survival. Although the bilirubin level was decreased by a PTBD, the survival was not improved. An extended lymphadenectomy along the hepatoduodenal ligament is necessary to prevent obstructive jaundice due to recurrence particularly, in patients with antrally located, moderately differentiated and Borrmann type-III carcinomas.